Vertebral fracture treatment techniques have evolved significantly over the years, starting from traditional methods that focused on pain relief only, to Vertebroplasty, which constituted a quantum leap at the time and with the need for better results with fewer complications, Balloon kyphoplasty came as an advanced step Today, this technique is a globally approved option, supported by strong clinical results, and is widely used due to its safety and rapid positive impact on the quality of life of patients, and Turkey is characterized by providing this technique with the latest medical methods, making it a preferred destination for patients from around the world.
What is balloon kyphoplasty?
Balloon kyphoplasty is an advanced medical technique aimed at treating compression fractures of the vertebrae of the spine, often caused by osteoporosis or minor injuries in the elderly. This procedure is an effective option to relieve pain and improve the patient’s quality of life without the need for major surgery or invasive intervention.
What is the basic therapeutic idea behind balloon kyphoplasty?
This technique is based on a simple but effective principle, which is to return the injured vertebra to its closest to normal position and then stabilize it to prevent further collapse or deformation, this is done using a special tool that gently lifts the collapsed part, creating a space that can be filled with a strong medical material that works to support the vertebra from the inside, the result is rapid pain relief and restoration of balance and stability in the spine.
What are the appropriate cases for balloon kyphoplasty?
The best treatment option for a compression vertebral fracture patient depends on a number of factors, including the severity of pain symptoms, the length of time since the fracture, the degree of loss of vertebral body height, the presence of anatomical abnormalities in the spinal structure, and the patient’s neurological stability. Balloon kyphoplasty is the best option in the following cases:
- Recent vertebral compression fractures: Usually due to osteoporosis or blunt trauma, with severe localized pain and failure of conservative treatment for two weeks.
- Vertebral fractures caused by tumors: Bone metastases (breast and prostate tumors) and multiple myeloma, where the fracture is painful and weakens the bone structure.
- Multiple fractures: Elderly people who have more than one recent vertebral fracture, resulting in severe back stoop, center of gravity misalignment, and relative respiratory insufficiency.
- Cases where the patient cannot tolerate prolonged rest: Such as heart patients or the elderly, whose bed rest can lead to complications such as strokes due to blood stagnation.
- A vertebral fracture that causes a spinal deformity (painful kyphosis): There is a decrease in the height of the vertebra, and the kyphosis angle is greater than 30 degrees.
- Non-recurrent but still painful and radiographically stable fracture
When is balloon kyphoplasty not advisable?
Balloon kyphoplasty is not advisable in cases where the fracture is simple and not accompanied by loss of vertebral height or deformity; in such situations, cement-only vertebroplasty is sufficient, as it is a simpler and less expensive procedure. Additionally, if the fracture is old, painless, or has healed spontaneously, no surgical intervention is recommended, whether by balloon kyphoplasty or any other method.
However, suppose there are signs of pressure on the spinal cord or nerve roots, such as limb weakness or urinary dysfunction. In that case, Balloon kyphoplasty is insufficient, and open surgery, such as vertebral stabilization, should be considered.
How does a patient prepare for balloon kyphoplasty?
The patient must prepare and prepare well before undergoing the operation to minimize the risks and achieve the best possible result, and to achieve this, it is necessary to follow steps and do some tests to ensure that he is healthy enough to undergo surgery, the following are the important steps of the things that must be done before surgery:
- Taking medications: Discuss the medications you are currently taking before undergoing balloon kyphoplasty. Your doctor may also prescribe certain medications, such as antibiotics to prevent infection, and you may be asked to stop taking certain medications, such as anticoagulants, to minimize the risk of bleeding during surgery.
- Showering: Ask the patient to take a shower to reduce the level of germs on the surface of the skin and thus reduce the risk of infection. The surgeon may request the use of antibacterial soap, and showering also helps in mental relaxation.
- Stop eating and drinking: The patient must stop eating and drinking at the time specified by the doctor before the surgery.
- Perform a physical examination
- Ordering a spinal X-ray, CT scan, or magnetic resonance imaging (MRI)
- Discuss any recent illnesses the patient has had
- Talk about any allergies the patient may have
- Ordering blood tests
- Reducing or quitting smoking
The date of the procedure will also be scheduled during this visit, so that the patient has time to prepare for it.
How is balloon kyphoplasty performed?
In the beginning, the anesthesiologist is responsible for assessing the patient’s general condition and deciding the appropriate type of anesthesia in coordination with the surgeon in charge of the procedure, either general anesthesia or moderate sedation (conscious sedation) is used, which allows the patient to remain in a low state of consciousness without feeling significant pain, the type of anesthesia is determined based on several factors, including the complexity of the procedure and the patient’s general health status.
After anesthesia, the patient is placed in a supine position on the abdomen on the operating table. A special radiographic device known as Fluoroscopy, a type of X-ray imaging, is used to accurately guide surgical instruments to the affected area of the spine. Through this technique, a hollow needle called a Trocar is inserted through the skin and soft tissues to reach the inside of the damaged vertebra.
Once the correct position is reached, the surgeon inserts a small balloon-like device through the Trocar into the body of the vertebra. This balloon is then gradually inflated as part of the balloon kyphoplasty procedure to restore the original height of the vertebra that was lost as a result of compression. This inflation helps create an internal cavity within the fractured vertebra.
After achieving the desired height and forming the appropriate space, the balloon is deflated, removed, and then injected with a special type of medical cement made of polymethyl methacrylate (PMMA) inside the formed cavity, this cement is characterized by its fast consistency and high hardness, used to stabilize the vertebra and prevent its collapse again, this stabilization contributes to reducing the chronic pain associated with vertebral fractures and improving the structural stability of the spine, and helps the patient restore part of the motor ability and daily activity.
This is a minimally invasive procedure compared to other spine surgeries and often has a relatively short duration, with the patient recovering in a short period of time with a significant improvement in symptoms.
After balloon kyphoplasty: Recovery and home care
After the balloon kyphoplasty procedure is completed, the patient undergoes an important recovery phase that requires following precise medical instructions to ensure the best results. Here are the full details of what to expect:
- The first period after surgery (24-48 hours): The medical team monitors vital signs (such as blood pressure and pulse) before allowing the patient to leave the hospital, painkillers are given as needed, as some mild pain or discomfort around the incision site is normal, and the patient is encouraged to move lightly such as a short walk on the same day to improve blood circulation and prevent clots.
- Return home and recover (first week): You can return to office work within days if the job is not physically demanding, but no heavy lifting or sudden bending for at least two weeks, avoid driving for at least 24-48 hours, keep the wound dry and clean, change the dressing as instructed by your doctor, and stay away from bathtubs or swimming pools until the wound is completely healed.
- Medical follow-up and long-term treatment: A follow-up visit is usually scheduled after one to two weeks to check the bone healing and the condition of the bone cement through X-rays, and drug treatment should be started if the cause of the fracture is osteoporosis, such as bisphosphonates with calcium and vitamin D supplements, also in some cases, physical therapy sessions are recommended to improve posture and strengthen the back muscles.
- Expected long-term results: Most patients notice significant improvement within 48 hours, with partial restoration of the length of the affected vertebra. It is advisable to maintain a healthy lifestyle (light exercise, calcium-rich diet) to prevent new fractures.
Benefits of balloon kyphoplasty
- Rapid pain relief: Most patients feel much better within 24-72 hours after balloon kyphoplasty.
- Reduces the need for strong painkillers: A reduction in the use of opioids has been observed, avoiding drug complications such as gastrointestinal disturbances, neurological effects, and fall risks.
- Partial restoration of vertebral height: Balloon kyphoplasty improves vertebral body height and corrects the kyphosis angle.
- Stabilizes the vertebra and prevents further compression: It strengthens the body of the vertebra and reduces the rate of new fractures.
- Improved mobility and walking ability: Balloon kyphoplasty allows for a quick return to daily activities and improves mobility.
- Minimize bed rest, which helps reduce the risk of venous thrombosis and pressure ulcers
- Improved quality of life as a result of pain relief and improved mobility, which helps the patient return to his social life and normal activity quickly
Balloon kyphoplasty is a non-invasive, time-consuming procedure that does not require physical therapy or rehabilitation afterward.
Difference between balloon kyphoplasty and traditional methods of spinal fracture treatment
Compression fractures of the vertebrae are a common complication, especially those resulting from osteoporosis in the elderly, and may result in functional and structural complications that significantly affect the patient’s quality of life. Traditionally, these fractures have been treated with conservative and non-invasive means, such as prolonged bed rest and the use of strong analgesics in addition to supportive means such as back belts or braces, along with progressive physical therapy. Although these approaches may be effective in some cases, they are often limited, as they aim to relieve pain and control symptoms, without any direct intervention in repairing the fracture itself or treating the resulting deformity.
However, these traditional methods show several limitations, especially when it comes to severe or persistent fractures. They do not contribute to the re-raising of the collapsed vertebra and do not prevent the deterioration of the lumbar curvature or the increase in postural deformity, which may lead over time to motor imbalance, reduced functional capacity and complications such as chronic pain, respiratory disorders and gastrointestinal issues due to the pressure on the organs, and the long recovery time under these treatments may contribute to complications associated with lack of mobility, such as venous thrombosis or loss of muscle mass.
Balloon kyphoplasty is a recent innovation that offers a safe and effective interventional solution. This technique is based on the principle of restoring the height of a partially collapsed vertebra by inserting a gently inflated medical balloon into the body of the vertebra. The resulting bone cavity is then injected with a cement that supports and stabilizes the vertebra in its new position.
This method is characterized by several advantages proven in the scientific literature, including: Rapid pain relief, improving mobility in a short time, reducing the need to use strong painkillers, and partially restoring normal strength, which reflects positively on other vital functions, and multiple studies have shown that the complication rates associated with this technique are low, especially when applied according to the appropriate criteria.
The fundamental difference between the two methods is that traditional methods focus on adapting to the injury, while balloon kyphoplasty seeks to correct it and restore the vertebrae to their normal structural position, representing a paradigm shift in the treatment of compression fractures and supporting a more effective approach in the medical care of spine patients.
In conclusion, Balloon kyphoplasty is a minimally invasive surgical procedure used to treat spinal fractures, where a small balloon is inserted into the broken vertebra. Then the balloon is inflated to restore the height of the collapsed vertebra. The space is filled with special cement to stabilize the vertebra and reduce pain, Balloon kyphoplasty surgery helps patients regain mobility and reduce pain and discomfort caused by spinal fractures, allowing faster recovery and improved quality of life.
Sources:
- Medical Advisory Secretariat. (2004). Balloon kyphoplasty: An evidence-based analysis. Ontario Health Technology Assessment Series, 4(12), 1-45.
- Ebeling, P. R., et al. (2019). The efficacy and safety of vertebral augmentation: A second ASBMR Task Force report. Journal of Bone and Mineral Research, 34(1), 3-21.
